Council on Medical Assistance Program Oversight Care Management pcmh committee



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Council on Medical Assistance Program Oversight


Care Management – PCMH Committee
Legislative Office Building Room 3000, Hartford CT 06106

(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306



www.cga.ct.gov/ph/medicaid

Co-Chairs: Rep. Michelle Cook & Rep. Catherine Abercrombie

June 13, 2012 Meeting Summary

Attendance:



Rep. Michelle Cook (Co-Chair), M. Alex Geertsma ( COC CTAAP), Ellen Andrews (CTHPP), Jesse White- Frese’(CT Assoication of School Based Health Centers), Sandra Carboarni( CT AAP), Evelyn Barnun(CT CACT), Mark Keenan (DPH), Thomas Kennedy(CHNCT), Patricia Fustino (CHNCT), Mary Krentzman(CHNCT), Lisa Honegdeld(CHDI), Annie Jacob(DSS), Erica Garcia (DSS), Rob Zavoski M.D.(DSS)
PCMH Update

Erica Garcia and Annie Jacobs from DSS gave the presentation on the PCMH/ Glide Path Update. Presentation is attached and on the MAPOC website.



PCMH Application Status

  • 27 Practice Applicants who submitted PCMH Applications

  • 9 Practice Applicants approved by DSS as PCMH

    • 92 Sites and 387 Practitioners

  • 2 Practice Applicants Pending Approval by DSS as PCMH’s

    • 8 sites and 45 Practitioners

  • 17 Glide Path Practice Applicants are in review by DSS

  • 37 Additional Glide Path Potential Eligible Sites

    • School Based Health Centers, Homeless Shelters, Mobile Vans, Pro Health

Thomas Kennedy gave an overview of the recruitment plan and update.

Recruitment plans have been moved to their offices. The practices participating are in C-MAP, NCQA recognized or very familiar with NCQA. Recruitment is working with the Glide Path Option in average practices to education what NCQA is and whether EHR (Electronic Health Record) has been made as an investment. EHR has been considered a large determinant whether the practice will be successful with Glide Path. The system needs to be in place to report meaningful use and meet all the points in Glide Path and NCQA.



  • 134 Practices Contacted since 1/1/2012

    • 99 Prospective Practices are in open status

  • 37 of the 99 prospects have live EHRs

  • Fairfield County Medical Association-PCMH Recruitment Presentation on 6/28/2012.

The presentation and decision of the Fairfield County Medical Association PCMH recruitment will take a large part in determining if other counties are open to PCMH.

PCCM Status is given.



  • PCCM Practice 29(7 FQHC’s and 22 Independent practices

    • 7 FQHC’s- 6 submitted PCMH applications and well as Glide Path Applications, 1 FQHC has not submitted application.

    • 7 PCCM Independent Practices have submitted applications.
    • 15 PCCM Independent Practices- No applications received to date.


Note: No Applicants to Date- means “practice readiness”

Comments and Discussion

  • Ellen Andrews beings the conversation contact with Electronic Health Associations in terms of outreach to practices.

  • CHNCT responds with comments about Electronic Record Associations have been making contacts and doing outreach to practices to provide gateway to EHR.

  • Question about how many Medicaid providers are in PCMH?

  • DSS responds by stating they are cleaning up to the enrollment process and are going to have a clear idea of how many are enrolled soon. There are a total of 688 total practitioners in PCMH. A number of them are PCP.

  • Recruitment to C-MAP providers and specialty wise look at revenue history with the Department and seeing who has the largest volume of C-MAP beneficiaries. ASO wants to reach as many C-MAP beneficiaries as possible.

  • DSS wants practitioners and practices to know what NCQA standards are and other opportunities to improve.

  • Dr. Geertsma stresses the point to have a thoughtful plan of improvement in quality, especially in children. In the design of the EHR the children aren’t always kept in mind when designed measures. There needs to be a plan of action to improve health outcomes through PCMH. There needs to be more public dialogue.

  • DSS states there are of a group of practitioners whose EHR are wrong by means of measuring meaningful use. The Quality Measures to collect data to see if there are outcomes will come out soon to report soon.

  • Rep. Michelle Cook would like an estimate of how many EHR are incorrect and if there are any adaptive programs to fix those problems.
  • DSS responds by stating there is a FQHC whose program needs to start over. It is a very high cost to fix start over with EHR. Hospitals have large systems in place with EMR but, kids aren’t always a priority in design. Small practices aren’t in a rush to change EMR systems because of the high cost, time, and training included. Having EMR system that doesn’t comply or match up with NCQA standards makes it difficult for practices reach those standards. Specialty doesn’t always have the same EMR systems either.


  • Dr. Geerstma asks what outcomes or proxy outcomes are they expecting. Are there any allocations in the contract with the ASO or federal grants to help practices facilitate new EHR systems? He stresses the point of predicting the type of data you will need to capture and plan for that in beginning (Adult/ Child Measures) when setting up the system with EHR.

  • There are questions about Day Kimball and Charlotte Hungerford Glidepath Applications.

Glidepath Program Enhancement

Patricia Fustino and Mary Kretzman gave the Glidepath Program Enhancement Presentation. The Presentation is attached and posted on the MAPOC Council Website.



Lessons Learned

Practice Support Documents

  • Readiness Evaluation Questionnaire

    • Sampling of Questions to practices and before they complete the applications.

  • 15 Month Work Plan

    • Each month there are different goals and work plans

  • Timelines

    • Not Recognized moving toward 2011

    • 2008 Recognized upgrading to 2011
  • CHNCT 15-Month Glide Path Calendar


    • Glidepath Deliverables

Enhancements to Glide Application

  • Standardized work plants within the application

  • Add NCQA crosswalk reference column to application

  • NCQA correlation within work plan

Benefits

  • Proactive Approach to application submission

  • Better identifies and defines each practices uniqueness prior to application process.

  • Supports a team of CPTS and Network Managers who are fully informed of a practice’s status prior to interaction.

  • Overview of Dialogue with ASO

  • Provides Satisfaction and efficiency

Process for Applications

  • Plan to complete Readiness Evaluate Questionnaire with practice.

  • Utilize new practice support documents to assist practices to identify potential caps in work plans.

  • Monitor and Evaluate Glide Path Progress toward NCQA recognition.

  • Education practices on the process to submit supporting documents to CHNCT.

Questions, Comments, Discussion

  • Ellen Andrews questions if there is engagement with patients because it is part of the PCMH and NCQA standards.

  • What are the transformation specialists doing with their patients?

  • What types of services are there to meet coordination care?

  • Responses from CHNCT- There are refining practice with the ASO infrastructure. Transformation specialists help coordinate care with people with chronic disease and other needs.

  • DSS- In year one of PCMH, Transformation Specialists starts going out into the community providing the most services possible.

  • Dr. Geertsma uses the spectrum of the medical home to help describes why schools want to get involved.


  • Sandy Carbonari stresses the importance of providing care coordination in pediatrics, especially children with chronic diseases. It is also difficult for families to coordinate those different medical needs the child has to have.

  • DSS responds- Intensive Care Managers are in the community to help collaborate (Value Options) with care coordinators.

Disclosure Information

DSS will table the discussion and report for August 8, 2012 meeting. The documents will be distributed in 2 weeks to help prepare to discussion and feedback at the August meeting. The documents will roll-out in 2 weeks.



Committee Open Discussion

  • Dr. Geerstma shares a story of successful care coordination with the use of community resources, preventive care management.

  • Rep. Michelle Cook inquires about a source of care coordinators to tap into.

  • Sandy Carbonari states there has been care coordinators identified informally

  • DSS- in Disease Management, the medical home has been used.

  • Mark Keenan (DCF) makes comments about the systems are built but are not coordinated all together. The systems are referring to different state funded programs that need to be threaded together to build complete care coordination. There is encouragement to include students and schools in the education process of care management. There needs to be collaboration between getting schools to understand how the state wants to coordinate care.
  • Lisa Honegfeld makes comments about how the State of Connecticut pays for programs to help make people healthier. The question is how to optimally coordinate care.


  • Dr. Geerstma makes statements about the fee for service structure and how it is suppose to coordinate care.

  • Ellen Andrews suggests making care coordination a better “friendly” system.

  • Jesse White-Frese’ makes comments about how disease management is done at one site. The integral parts of the system are how care management should be local and include family communication.

  • Rep. Michelle Cook makes comments about how it is difficult to define and education the role of care manager, especially dealing with chronic disease. Education and integration of care management to set the foundation for the future.

  • Ellen Andrews suggests an Allied Health Workforce Board has done research on the education of care management and suggests they do a presentation at one of the next PCMH meetings.

  • Rep. Cook and the group agree on the presentation. Olivia Puckett will set up and coordinate the presentation.

  • CHNCT makes comments about how the patient needs to trust the provider make a medical home work.

  • Sandy Carbonari makes comments about how the care coordination within school systems.

  • Care coordinators will be going into practices and see what is available to provide care coordination services. Care coordinators will provide the connection. Intensive Care managers will be a contact in the Care Coordination process between practices.

Meeting ends at 11:30 AM.

Next meeting date: August 8, 2012




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